Dear doctor baskaran, <\n\n> Thank you very much for your help last night and advice over the phone I'm sorry for disturbing you but really do appreciate you taking the time to talk to me talk me through the case and for your sage advice shortly after we talked he had a loading dose of keppra but unfortunately didn't improve and remained gcs 3 his subsequently his saturations dropped to 70% or so and his blood pressure was about 80 systolic I had a long discussion with the family and they felt that he wouldn't want any further invasive treatment and so we made a plan to switch to palliative care for him the family were in full agreement with this plan and so we have weaned the noninvasive ventilation and put him on a palliative care pathway unfortunately we didn't see any improvement with his parkinsonian crisis during the time he was receiving the patch but appreciate your advice all the same I just thought you should know the outcome thank you very much